Provider Demographics
NPI:1922807999
Name:BAMBOT, DESMOND
Entity type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:BAMBOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 SIR GALAHAD RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8923
Mailing Address - Country:US
Mailing Address - Phone:571-835-1505
Mailing Address - Fax:
Practice Address - Street 1:5808 SIR GALAHAD RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-8923
Practice Address - Country:US
Practice Address - Phone:571-835-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD-10272278850172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker